Air pollution crisis: Buy health insurance policy that covers your lungs

Delhi’s air pollution has surged to hazardous levels this week, leading the government to impose measures aimed at curbing exposure. Schools have been shut, offices are functioning at half-capacity, and authorities are exploring artificial rain to combat the toxic smog.  

 

The primary culprit is PM2.5, microscopic particles that can infiltrate the lungs and bloodstream, causing severe respiratory and cardiovascular health risks, according to the Central Pollution Control Board. Experts warn that the crisis is not just environmental but also a public health emergency.  

 

Health insurance demand rises as respiratory illnesses grow  

 

With worsening air quality, health insurers are seeing a spike in claims related to lung diseases. “There’s been a marked rise in people seeking treatment for respiratory conditions in recent years, especially in metros like Delhi,” said Dr Pankaj Shahane, vice president of health claims at Go Digit General Insurance. “The connection between pollution and respiratory ailments is undeniable.”  

 

 

Conditions such as COPD (chronic obstructive pulmonary disease) and asthma have shown alarming increases. “Over the last decade, these cases have risen by 25%,” noted Shahane.  

 

At Onsurity, claims for lung diseases, including bronchitis, asthma, and interstitial lung disease (ILD), have jumped 58% year-on-year in FY24 compared to FY23. “Even among individuals under 40, we’re seeing a noticeable rise, demonstrating the widespread impact of air pollution,” said Suman Pal, chief claims officer at Onsurity.  

 

What health insurance covers  

 

Health insurance policies in India generally include coverage for various respiratory conditions such as asthma, COPD, and even severe cases like lung cancer. Coverage typically extends to:  

Hospitalisation costs: Inpatient care for treatment of respiratory conditions.  

Outpatient care: Expenses for consultations, diagnostic tests, and prescribed medications.  

Preventive services: Screenings for lung cancer and other respiratory diseases, often accompanied by wellness benefits like teleconsultations and discounts on medicines.  

 

“Comprehensive policies are essential for managing these conditions. They offer benefits like pre- and post-hospitalisation care, consultations, and pharmacy expenses,” explained Dr Santosh Puri, senior vice-president at Tata AIG General Insurance.  

 

Costs and regional considerations  

 

Health insurance costs can vary depending on coverage and the number of family members insured. Dr Puri provided an example: “A family of three living in Mumbai, including two adults and a dependent child, would pay Rs 25,703 annually (excluding taxes) for Rs 10 lakh coverage under Tata AIG MediCare Premier.”  

 

While insurers do not currently charge different premiums based on regional air quality, the possibility is being explored. “We are considering risk-based pricing models where factors like air pollution could influence premiums in the future,” said Sharad Mathur, MD and CEO of Universal Sompo General Insurance.   

Premiums vary based on age, medical history, sum insured, and add-ons chosen, according to Siddharth Singhal, Head of Health Insurance, Policybazaar.

 

Here are the plans and premiums for a single adult, aged 30, residing in Delhi, with a Rs 1 crore base cover, as per Policybazaar:

 

Care Health:

Plan Name: Care Advantage

Premium (including GST): Rs 13,159

 

Star Health:

Plan Name: Smart Health Pro

Premium (including GST): Rs 15,515

 

Manipal Cigna:

Plan Name: Lifetime Health

Premium (including GST): Rs 13,297

 

Aditya Birla Health Insurance:

Plan Name: Activ Fit Plus

Premium (including GST): Rs 17,058

 

Niva Bupa Health Insurance:

Plan Name: Reassure 2.0 Platinum

Premium (including GST): Rs 24,605

 

HDFC Ergo:

Plan Name: Optima Secure

Premium (including GST): Rs 25,781

 

Innovations in health insurance  

 

Insurers are increasingly offering preventive benefits. Mathur detailed some initiatives:  

Free or subsidised air purifiers for policyholders.  

Fitness tracking and pollution-monitoring apps.  

Complimentary annual health check-ups focused on respiratory health.  

Teleconsultations with pulmonologists or general practitioners.  

 

These additional benefits aim to reduce health risks and long-term costs for policyholders.  

 

Chronic conditions and waiting periods  

 

For chronic lung conditions like ILD, coverage depends on the type of policy. Individual policies often exclude pre-existing conditions or impose waiting periods of one to four years. “At Tata AIG, pre-existing conditions are covered after 24 months of continuous coverage under the MediCare Premier plan,” said Dr Puri.  

 

Group health insurance policies, however, offer more flexibility. “Group policies usually cover pre-existing diseases from day one, eliminating the waiting period,” said Shahane.  

 

Pal highlighted Onsurity’s approach: “Our comprehensive plans for ILD include benefits like OPD consultations, diagnostic tests, and regular pulmonary specialist visits.”  

 

Long-term treatment expenses  

 

Medication costs for chronic conditions can be steep. For instance, Ninetab, prescribed for ILD, costs Rs 1,000 per strip and must be taken lifelong. “While health insurance typically covers medications during hospitalisation, outpatient drug coverage varies,” said Shahane.  

 

Pal pointed to alternatives: “Some insurers provide riders for chronic medications or offer critical illness plans with lump-sum benefits for severe conditions like lung cancer. At Onsurity, we also offer drug discounts through partnered pharmacies, which significantly reduce out-of-pocket expenses.”  

 

Exclusions to be aware of  

 

Policies often exclude coverage for:  

Non-disclosed pre-existing conditions.  

Experimental treatments not approved by regulatory authorities.  

Smoking-related damage if explicitly excluded.  

 

“Claims for undisclosed conditions like ILD or lung fibrosis can be denied,” said Shahane.  

 

Pal added that treatments not aligned with standard medical practices, including cosmetic or experimental procedures, are also excluded.   

Pre-existing conditions: "If you have a pre-existing lung disease, many insurers impose a waiting period (typically 2–4 years) before covering treatment for that condition. You can go for a PED reduction rider which can completely waive off the waiting period," said Singhal.

 

Alternative therapies: According to Singhal, coverage for alternative or traditional treatments like Ayurveda, homeopathy, or naturopathy is often excluded for lung diseases, even if they may provide relief.

 

Why respiratory health demands attention  

 

India bears a heavy burden of respiratory diseases. The Global Burden of Disease Report 2017 revealed that India accounts for 15.69% of global chronic respiratory cases and 30.28% of deaths. COPD affects 55.23 million people in India, with nearly 0.85 million deaths annually.  

 

“Acute respiratory infections make up 69.47% of morbidity cases,” said Dr Puri, citing the National Health Profile 2019. “The prevalence of these issues shows why comprehensive health coverage and preventive care are essential.”